| Objective:Through the analysis of all clinical data collected from Newly diagnosed Multiple myeloma(MM)patients and the comparison of various literatures,in order to discuss the clinical characteristics of Multiple myeloma in our hospital and analyze prognostic factors affecting MM,so as to provide a basis for early diagnosis and effective treatmentMaterials and methods:Clinical data of patients with multiple myeloma initially treated in Jinan central hospital from January 1,2013 to November 1,2018 were collected.A total of 75 patients were diagnosed,and all of them met the diagnostic criteria of China's multiple myeloma diagnostic guidelines(revised in 2015)[27].Gender,age,routine blood,serum creatinine,blood calciume,lactate dehydrogenase,serum albumin,serum protein electrophoresis,immune fixation electrophoresis,quantitative,serum immunoglobulin beta 2-microglobulin,kappa/lambda values predominate,routine,bone marrow biopsy and bone marrow fluid cytology,fluorescence in situ hybridization,chromosome,immune classification,D-S stage,ISS and RISS stage,prognosis factors,treatment plan were analyzed retrospectively.SPSS 19.0 statistical software was used to process all data and conduct data analysis,and P<0.05 was statistically significant.Results:75 patients with MM were analyzed,there were 54 male patients and 21 female patients(male:female 2.57:1),aged 35-82 years old,with a median age of 57 years old,including 55 patients over 50 years old.The clinical manifestations of all patients are lack of specificity,and the diagnosis requires restrictions such as bone marrow puncture,which are easily ignored by physicians,especially non-hematologists.The rate of misdiagnosis is high,up to 65.17%.Among them,bone pain was the most common clinical symptom,accounting for 81.3%in 61 cases,and 16 cases(21.3%)of upper abdominal discomfort,edema,fever,local mass and nerve root stimulation.The majority of the 75 MM patients were IgG type,accounting for 56%,followed by IgA type,accounting for 20%,followed by light chain type,accounting for 13.3%.Analysis of prognosis of MM patients revealed that age(P=0.005*),beta 2-microglobulin(P=0.000*),serum albumin(P=0.000*),ISS stage(P=0.000*),RISS stage index(P=0.000*),FISH test(P=0.000*)had statistically significant differences in prognosis of MM patients,which were independent risk factors affecting the prognosis of MM.treatment options(P=0.000*)also had significant differences in MM prognosis.Gender(P>0.05),hemoglobin(P>0.05),leukocyte(P>0.05),serum calcium(P>0.05),serum creatinine(P>0.05),lactate dehydrogenase(P>0.05),platelet count(P>0.05),and ?/? value(P>0.05)were not statistically significant for the prognosis of MM patients.Among the 75 MM patients,60 underwent FISH examination.According to the Mayo clinic mSMART 3.0 version,the risk stratification was divided into standard risk patients and high-risk patients.42 patients were classified as standard risk patients,accounting for 70.0%,and 18 patients were classified as high-risk patients,accounting for 30.0%.The concept of"double strike" and "triple strike"was proposed,which was defined as patients with any two or three chromosomal abnormalities in the high-risk group.Obviously,there are two or even three high-risk chromosomal abnormalities in cytogenetic abnormalities,the prognosis is extremely poor.Multiple myeloma patients should be treated with individualized comprehensive therapy,including chemotherapy,autologous stem cell transplantation and symptomatic support therapy.Among them,chemotherapy was the main treatment scheme for MM,including the treatment with bortezomib and conventional chemotherapy.A total of 12 of the 75 MM patients in this study refused any chemotherapy for various reasons,accounting for 16.0%.A total of 43 cases(57.3%)were treated with bortezomib(commercial name:Wanke)in induction therapy.A total of 20 cases(26.7%)were not treated with bortezomib(commercial name:Wanke).Through follow-up,it can be seen that the choice of treatment scheme has no statistical significance for the difference in MM prognosis(P:=0.673).For patients suitable for hematopoietic stem cell transplantation,chemotherapy containing bortezomib should be given at the early stage,which has a higher remission rate and is more suitable for transplantation.But MM is still incurable,and its treatment is still being explored.Conclusion:Multiple myeloma patients mostly occur in middle-aged and elderly patients,and their clinical manifestations are all non-specific,which may cause anemia,infection,bleeding,bone pain,even fracture and other symptoms,and may even show rare clinical symptoms such as nerve root stimulation sign and local masses.Bone pain was the leading cause of admission,followed by anemia-related clinical manifestations.The diagnosis of MM mainly depends on serological examination,bone marrow examination,FISH,chromosome examination and clinical manifestations.Analysis of prognosis of MM patients revealed that age,beta 2-microglobulin,serum albumin,ISS stage,RISS stage index,FISH test had statistically significant differences in prognosis of MM patients,which were independent risk factors affecting the prognosis of MM,treatment options(P=0.000*)also had significant differences in MM prognosis.Gender,hemoglobin,leukocyte,serum calcium,serum creatinine,lactate dehydrogenase,platelet count,?/? value were not statistically significant for the prognosis of MM patients.With the increase of risk,the detection rate of chromosomal abnormalities gradually increased.At present,patients are mainly divided into prognostic groups based on IPSS-R,and individualized treatment options are selected for different patients through clinical classification,economic stratification and medical insurance reimbursement policies.After chemotherapy,ASCT is still the standard treatment to improve the remission rate and prolong the survival of MM patients.But all the new solutions still cannot cure MM,they still have their own limitations,so we still need to constantly explore the new therapy. |
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